Treatment for unicameral bone cysts in long bones: an evidence based review

• Main Authors: Sandra E. Donaldson, Josie Chundamala, Suzanne Yandow, James G. Wright
• Format: Article
• Language: English
• Published: Open Medical Publishing 2010-05-01
• Series: Orthopedic Reviews
• Subjects: Orthopaedics; Pediatrics; Unicameral bone cyst; Surgery; Treatment; Levels of evidence
• Online Access: http://www.pagepress.org/journals/index.php/or/article/view/1759
• ISSN: 2035-8237; 2035-8164

The purpose of this paper is to perform an evidence based review for treatment of unicameral bone cysts. A search of MEDLINE (1966 to 2009) was conducted and the studies were classified according to levels of evidence. This review includes only comparative Level I-III studies. The systematic review identified 16 studies. There is one level I study, one level II study and the remaining 14 studies are level III. Seven of the sixteen studies had statistically different results: three studies indicated that steroid injection was superior to bone marrow injection or curettage and bone grafting; one study indicated that cannulated screws were superior to steroid injections; one study indicated resection and myoplasty was superior to steroid injection; one study indicated a combination of steroid, demineralized bone matrix and bone marrow aspirate, and curettage and bone grafting were superior to steroid injection; and one study indicated that curettage and bone grafting was superior to non-operative immobilization. Based on one Level I study, including a limited number of individuals, steroid injection seems to be superior to bone marrow injection. As steroid injections have already demonstrated superiority over bone marrow injections in a randomized clinical trial, the next step would be a prospective trial comparing steroid injections with other treatments.